FOI 26-263 - Medical Gas Cylinders

Freedom of Information Request

Request Date

11 Jun 2026

Response Date

02 Jul 2026

Information Requested

I am requesting detailed information regarding the management, governance and financial control of medical gas cylinders used by the Scottish Ambulance Service. Given that medical gas cylinders incur ongoing rental and replacement costs, and are essential to the delivery of frontline patient care, I wish to understand the scale of any losses, associated financial liabilities, and the controls in place to safeguard public funds and maintain operational readiness. Please provide the following information for the period 1 April 2020 to the most recent date available:

Q1 - The total annual expenditure incurred by SAS for:

a)Medicalgas cylinder rental charges;
b)Medicalgas cylinder refills;
c) Replacement cylinders;
d) Lost-cylinder charges, non-return charges or other supplier charges relating to missing cylinders.

Please provide a yearly breakdown where available.

Q2 - The total number of medical gas cylinders recorded as:

a) Lost;
b) Missing;
c) Unaccounted for;
d) Written off; or
e) Subject to supplier charges due to non-return,

Broken down by year and, where recorded, by cylinder type.

Q3 - Please provide the total value of any provision, write-off, settlement, impairment, accrual, financial liability or similar accounting adjustment recorded by SAS in relation to missing, unreconciled or unreturned medical gas cylinders during the period requested.

Q4 - Please provide any final audit reports, stocktake reports, governance papers, risk assessments, investigation reports or management reviews produced within the past five years concerning:

a)Medicalgas cylinder losses;
b) Cylinder reconciliation exercises;
c) Rental liabilities;
d) Stock-control weaknesses;
e) Traceability of cylinders; or
f) Measures introduced to improve accountability and stock management.

Q5 - Please provide any final reports, submissions, briefing papers, business cases, audit reports, financial assessments, governance papers or correspondence provided to NHS Scotland and Scottish Government officials or Ministers concerning:

a)Medicalgas cylinder losses;
b) Missing or unreconciled cylinders;
c) Rental liabilities;
d)Financialexposure;
e) Stock-control concerns;
f) Recovery plans; or
g) Any requirement foradditionalfunding, write-off approval or financial settlement.

Q6 - Please provide the name of the current supplier or suppliers of medical gases to SAS, together with:

a) The contract commencement date;
b) The contract expiry date; and
c) The total annual expenditure under the contract for each year requested.

Q7 - Please provide details of any cylinder-tracking, scanning or traceability system introduced, piloted or implemented during the past five years, including:

a) Implementation dates;
b) Areas or regions involved;
c) Staff groupsrequiredto use the system;
d) Any training materials, guidance documents or SOPs issued;
e) Any recorded compliance,auditor evaluation reports.

Q8 - Please provide any recorded assessments of:

a) The effectiveness of cylinder-tracking measures;
b) Compliance rates;
c) Data quality;
d) Operational impact;
e) Staff workload implications; and
f)Financialsavings or losses avoided.

Q9 - Please provide the current policies, SOPs, guidance documents or work instructions governing:

a) Receipt of medical gas cylinders from suppliers;
b) Storage at ambulance stations;
c) Allocation to vehicles;
d) Exchange of empty cylinders;
e) Recording and reconciliation processes;
f) Investigation of missing cylinders; and
g) Responsibilities of staff and managers for stock control.

Q10 - Please provide the most recent recorded figure held by SAS for:

a) The total number of medical gas cylinders on issue to the Service;
b) The total number physically accounted for;
c) The total number outstanding,unreconciledor otherwise unaccounted for.

If any information is exempt from disclosure, please provide any reasonably separable non-exempt information. If any information is not held, please confirm this under Section 17 of FOISA.

Response

Q1 – The Q1 Tab on the attached sheet details the total recorded medical gas expenditure held by SAS for the period requested. Detailed categorisation of expenditure, such as rental, product/refill, delivery and collection charges, is only available from 1 April 2024 following changes to financial reporting. For earlier years, the expenditure is held as an overall total and is not available in the detailed categories requested.

The Scottish Ambulance Service does not hold a separate annual category for “lost-cylinder charges” or “non-return charges” across the full period requested. Where figures relate to proposed or approved write-off activity, these are addressed below.

Q2 - The Scottish Ambulance Service does not hold the information requested; it is for this reason we have applied section 17 of the Freedom of Information Scotland Act 2002 as information not held.

To explain the application of this exemption, the Service does not maintain a year-by-year dataset recording medical gas cylinders as lost, missing, unaccounted for, written off, or subject to supplier charges due to non-return, nor is this information routinely recorded in a format that would enable the requested annual breakdown to be produced.

The Service is currently undertaking a programme of work to improve cylinder management and has implemented a tracking application to provide greater visibility of cylinder locations. As part of this work, audits have been undertaken which provide a snapshot of cylinders that could not be accounted for at a particular point in time. However, these audits do not constitute a record of annual losses or write-offs and would not provide a reliable response to the question as asked.

In addition, the position identified during an audit is subject to change. Since the introduction of the tracking system, cylinders previously considered unaccounted for have subsequently been located, and further cylinders may be identified as the tracking system continues to be rolled out and utilised across the Service. We therefore consider that providing audit snapshots in response to this question would be potentially misleading and would not accurately represent the current position.

Q3 - SAS is currently working through an assurance process to identify and validate the number of cylinders that remain unaccounted for. This includes activity to maximise recovery of cylinders, including expired cylinders, and to reconcile SAS records with supplier-held information.

The final number of cylinders to be treated as unaccounted for has not yet been confirmed. There will also be further supplier engagement before any final settlement or write-off position is agreed.

SAS has not yet been liable for final replacement cylinder charges during the period requested. Projected replacement/write-off costs are being withheld under section 30(b)(ii) of FOISA, as disclosure at this stage while supplier reconciliation and any associated negotiation remain ongoing.

To the extent that this part of the request seeks a final recorded settlement, write-off or liability figure, this information is not held under section 17(1) of FOISA, as the final agreed position has not yet been determined.

Q4 - We have identified the attached documents as falling within the scope of your request.

Some information has been redacted under:

Section 30(b)(ii) of FOISA – Free and frank exchange of views for the purposes of deliberation;

Section 33(1)(b) of FOISA – Commercial interests and the economy; and

Section 38(1)(b) of FOISA – Personal information.

The Scottish Ambulance Service recognises the importance of openness and transparency regarding its management of medical gases. However, a number of the documents relate to a programme of work that remains under active development and implementation. Releasing detailed deliberations, options under consideration, draft actions and stakeholder discussions would be likely to substantially inhibit the ability of staff and third-party organisations to engage in full and frank discussions as the work progresses. For this reason, some information has been withheld under section 30(b)(ii).

Certain information has also been redacted under section 33(1)(b) as it contains commercially sensitive material relating to contractual arrangements, pricing information, supplier relationships and financial considerations. Disclosure of this information would, or would be likely to, prejudice substantially the commercial interests of the Scottish Ambulance Service and/or third parties.

Personal data relating to individuals has been removed under section 38(1)(b) of FOISA.

As this work remains ongoing, some information contained within the documents reflects options, assumptions, risks or actions that have subsequently changed or been superseded during the implementation of improved cylinder management processes. Disclosure of these redacted discussions without the benefit of the ongoing context may therefore present an incomplete or misleading picture of the current position.

Q5 – The Scottish Ambulance Service has kept Scottish Government informed throughout a programme of work to improve the governance and management of medical gas cylinders.

We considered information relating to engagement with NHS Scotland and Scottish Government officials on these matters. The Service holds a final Internal Audit Report produced by KPMG, which was shared with Scottish Government and is provided in response to this request.

The Service also holds correspondence between Scottish Ambulance Service and Scottish Government officials relating to these matters. This information is exempt from disclosure under section 30(b)(ii) of FOISA (free and frank exchange of views for the purposes of deliberation).

Disclosure of this correspondence would be likely to inhibit substantially the free and frank exchange of views between officials while work remains ongoing. Officials require a private space to discuss developing issues, options and actions candidly to support effective decision-making.

We recognise the public interest in transparency regarding the management of public resources. However, there is a greater public interest in allowing officials to engage in open and honest discussions while work is ongoing. On balance, we consider the public interest lies in maintaining the exemption

Q6 - The current contracted supplier of medical gases to SAS is:

Supplier: BOC Ltd Contract reference: LPP/2022/002 Contract commencement date: 1 April 2025 Contract expiry date: 31 March 2029 Contract duration: 48 months Contract agreement value: £4.2 million over the full contract period

Annual expenditure information held by SAS is provided in response to question 1.

Q7 - SAS has introduced a cylinder tracker app to improve traceability of medical gas cylinders.

Following successful pilot work in 2025, a national SAS audit took place in September 2025. The app was implemented nationally in SAS on 2 February 2026. Prior to the internal cylinder tracker app, Manual counts were used for previous cylinder audits.

The implementation is national and includes all regions. It applies to stations, co-location bases and relevant operational areas, including:

Special Operations Response Team;

ScotSTAR / Air Ambulance;

Community First Responder schemes;

BASICS Scotland;

Scottish Mountain Rescue.

The system is used by approximately 4,000 Accident and Emergency operational staff, as well as Patient Transport Service Team Leaders.

Training and guidance have included:

live drop-in sessions;

frequently asked questions document

phone setup instructions;

user guidance for the app;

staff engagement session

SAS also holds draft SOPs relating to:

ordering, requisition and management of medical gases;

accountability and management of medical gas cylinders;

storage and access control of medical gas cylinders.

These SOPs are currently draft and pending approval. They are not being provided as current approved policy or SOP documents. To the extent that draft SOPs are requested, these are being withheld under section 30(b)(i) and/or section 30(b)(ii) where disclosure would inhibit substantially the free and frank provision of advice or exchange of views during development.

Q8 - SAS holds information within audit reports, project updates and dashboard reporting relating to the effectiveness and use of the cylinder tracking arrangements.

As of 27th June 2026, over 9,000 cylinders had been scanned by SAS staff. Scanning activity had been recorded against:

656 vehicles;

121 stations/bases;

9 hospitals;

13 Community First Responder schemes;

2 Scottish Mountain Rescue Teams.

As of the 27th June 2026, 1,155 staff had used the app. There is still on-going work implementing an action plan to extend app usage and maximise coverage.

A dashboard has been developed to give regional and national operational staff improved insight into medical gas usage at station, sub-regional and regional level. The dashboard uses current live app scanning activity and weekly BOC data, including stock holding reports, deliveries and returns, and cylinders exchanged with other emergency services, territorial health boards and other BOC customers.

The improvements in cylinder management are expected to support financial savings and cost avoidance by reducing unnecessary rental costs and mitigating the risk of future cylinder losses. However, SAS does not yet hold a final recorded figure for realised savings or losses avoided as the work is still ongoing. To the extent that your request seeks a final quantified savings figure, this information is not held under section 17(1) of FOISA.

Q9 - The current approved documents relevant to this part of the request include:

SAS Medicines Management Policy v1.3;

Update relevant audit and project documentation on cylinder management and reconciliation.

The Medicines Management Policy includes accountability for the management of medicines, including medical gases. It identifies responsibilities for relevant staff and managers in relation to stock control and safe management.

In relation to the specific points raised:

Requested area	Response
Receipt of cylinders from suppliers -	Each delivery has electronic proof of delivery. Invoices are paid nationally.
Storage at ambulance stations -	Only stations with approved medical gas stores are permitted to store gases.
Allocation to vehicles -	Current approved clinical guidance is provided.
Exchange of empty cylinders -	Cylinders are generally replaced on a like-for-like basis to maintain stock holding, with exceptions where justified, for example seasonal demand or return of surplus stock.
Recording and reconciliation -	The Medicines Management Policy provides accountability for medicines management, including medical gases. Additional tracking is supported by the cylinder tracker app and dashboard.
Investigation of missing cylinders -	Relevant audit reports describe the national audit and reconciliation activity to identify cylinders across stations, vehicles and relevant third-party locations.
Staff and manager responsibilities -	The Medicines Management Policy sets out responsibilities. Day-to-day oversight is typically undertaken locally, including by Paramedic Team Leaders, with Area Service Managers accountable for local arrangements.

Draft SOPs are under development but not yet approved. These are not being provided as current approved SOPs.

Q10 - The most recent recorded figure held by SAS, as provided by BOCfor the total number of medical gas cylinders on issue to the Service is 10,937 cylinders

SAS does not hold a single live, fully reconciled real-time figure for the total number physically accounted for in the precise terms requested as this is reliant on the app being used by all staff. The reconciliation process therefore remains ongoing and is subject to governance and assurance. To the extent that your request seeks a live, fully reconciled figure for the number physically accounted for, this information is not held under section 17(1) of FOISA.

Information relating to the current unresolved reconciliation position and any anticipated supplier settlement/write-off value has been withheld under section 33(1)(b) of FOISA, as disclosure at this stage would be likely to prejudice substantially SAS’s commercial interests in ongoing supplier discussions.

FOI 26-263 - Medical Gas Cylinders

Freedom of Information Request

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